Hyperkalemia captopril

Hyperkaiemia Elevated serum potassium (at least 0.5 mEq/L greater than the upper limit of normal) was observed in 0.4% of hypertensive patients given trandolapril, approximately 1% of hypertensive patients given benazepril, enalapril, ramipril, or moexipril approximately 2% of patients receiving quinapril or lisinopril, approximately 2.6% of hypertensive patients given fosinopril, and approximately 4.8% of CHF patients given lisinopril. Hyperkalemia also occurred with captopril. Vaivuiar stenosis Theoretically, patients with aortic stenosis might be at risk of decreased coronary perfusion when treated with vasodilators, because they do not develop as much afterload reduction as others. 

The hypotensive response to captopril is accompanied by a fall in plasma aldosterone and angiotensin II levels and an increase in plasma renin activity. Serum potassium levels are not affected unless potassium supplements or potassium-sparing diuretics are used concomitantly this can result in severe hyperkalemia. 

Because indomethacin may increase serum potassium concentrations, indomethacin and spironolactone should be administered concomitantly with caution. Potassium-sparing diuretics should be used with caution, and serum potassium should be determined frequently in patients receiving an angiotensin-converting enzyme (ACE) inhibitor (e.g., captopril). Concomitant administration with an ACE inhibitor may increase the risk of hyperkalemia. The dosage of spironolactone should be reduced, or the drug discontinued, as necessary. Patients with renal impairment may be at increased risk of hyperkalemia [65]. 

Adverse effects observed at therapeutic doses include cough, dermal reactions, blood dyscrasias, bronch-ospasm, and hypogeusia. Angioedema has been reported, but does not appear to be an IgG related immune response. Reversible renal failure has been reported with chronic therapy. Clinical effects that may occur include hypotension with or without a reflex tachycardia, changes in level of consciousness that are directly related to vascular changes, and hyperkalemia. Hyperkalemia can occur as a response to sodium loss. Delayed hypotension, at 19 and 25 h, has been observed following ingestion of captopril. 

Nonsteroidal antiinflammatory agents may impair the hypotensive effects of captopril by blocking bradykinin- and prostaglandin-mediated vasodilatation. Triamterene-induced hyperkalemia is enhanced by captopril. 

Bumakis TG, Mioduch HJ. Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia.ylrch/nferwMei (1984) 144, 2371-2. 

Electrolyte balance Hyperkalemia (6.0 mmol/1) has been reported in an 18-month-old child who had received long-term captopril after an elective operation on a type 1 truncus arteriosus defect [44 ]. The child also had anemia, presumed to be due to erythroid hypoplasia. 

Sunder RA, Rakesh G, Rudingwa P, Chanderlekha. Captopril induced hyperkalemia in a child. Paediatr Anaesth 2009 19(4) 404-5. 

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